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This is a detailed account of a medical emergency that occurred during our September 2024 Ararat expedition. One of our climbers developed High Altitude Pulmonary Edema (HAPE), required urgent evacuation from high camp, and spent several days in hospital — including time in the ICU. He is making a full recovery. I'm writing this because the lessons are worth sharing.
Severe altitude sickness on Ararat is not a common occurrence, and that's not wishful thinking — the mountain's structure makes it genuinely lower risk than many peaks of similar height. At 5,137m, it's not a small mountain. But on the standard route, you spend three nights at Camp 1 (3,300m), one night at high camp (4,200m), and the summit push is a round trip of around 10 hours — we did it in eight. As a standalone volcano, Ararat also allows for fast descent: high camp to base camp in roughly two hours, summit to high camp in about three.
That descent profile matters. When people start feeling bad, they can go down — or simply not go up. That's what happened with another member of our group, who made the sensible call to turn back without incident.
The flip side of this low-risk profile: local guides rarely encounter anything beyond mild altitude sickness. There are no medical professionals in the camps. No standby rescue team, no helicopter on call. Guides cooperate to handle emergencies as best they can, but the infrastructure simply isn't there. Neither our camp nor the surrounding camps had supplemental oxygen or Dexamethasone — the drug most commonly used as emergency treatment for HAPE and HACE.
The other complicating factor: the climber in question was an ultra-marathon runner. He had an exceptional tolerance for discomfort. What would have sent most people down the mountain wasn't enough to stop him — and that worked against him.
If you don't have extensive high-altitude experience, lack of reference is a real problem. You know you're supposed to feel worse at altitude — but how much worse? That's a hard question to answer before it becomes too late.
On our first night at Camp 1 (3,300m), I took oxygen saturation readings with a finger sensor. The results weren't perfectly reliable, but the pattern was clear: most of the group was sitting at 85–90% saturation. This climber was at around 75%. His Garmin watch showed a similar reading. We talked about it — he acknowledged he might have some trouble acclimatising, but said he felt reasonably well. We moved on.
In retrospect, a reading that far below the rest of the group was a meaningful early warning. We saw it. We didn't act on it decisively enough.
The next day — the acclimatisation hike up to high camp and back — went better than expected. He kept pace with the group, completing the 3.3km, 750m climb in 2.5 hours when the guides had estimated 3–3.5. In my experience, people developing serious altitude sickness struggle to maintain group pace. This reduced my concern. It probably shouldn't have reduced it as much as it did.
The following morning we moved to high camp for real. One group member had already decided not to continue — this climber chose to press on. The pace was slower than the acclimatisation day, but he kept up. That evening he mentioned it was harder than usual to maintain his balance, but felt confident enough to stay the night and see how he felt before the summit push.
During the night he coughed significantly. I asked him directly: dry cough or wet? He said it seemed dry. A dry cough is common at altitude and relatively benign. A wet, productive cough is one of the classic signs of HAPE — fluid accumulating in the lungs. Other climbers in the tent later told me it sounded wet to them. This points to something important: it can be very hard for a climber to accurately self-assess wet versus dry cough, especially when they're already impaired.
By the time we prepared for the summit push, he had decided not to attempt the summit — he'd stay at camp and descend with us when we returned. The oxygen sensor wasn't giving reliable readings for him at that point. We left him with the camp manager and set off at 1:30am.
We were back from the summit by around 10am. From a distance I spotted a figure moving very slowly toward the toilet block, supported by another person. I recognised him immediately. In the nine hours since I'd last seen him, he had deteriorated dramatically.
He was sitting in direct sunlight, lethargic and barely responsive to his surroundings — not attempting to move out of the sun despite what should have been discomfort. His breathing was laboured. His pulse was elevated. When I spoke to the guides about the evacuation plan, they said the horses would come and he'd go down with a guide on each side. They'd handled plenty of mountain emergencies before — mostly broken bones and sprained ankles — and were confident this was manageable.
I asked about a doctor on call, about emergency medication, about anything we could do right now. The response: they had 25 years of guiding Ararat, he'd feel better once he got lower. They gave him water with electrolytes. That was the plan.
He was getting worse almost by the minute. I could see he was having trouble staying upright in the chair and was drifting toward unconsciousness.
The guides grew concerned that he might not be able to stay on a horse — that he could fall asleep and fall off. At one point they suggested he should sleep for a while. I believe they thought he had taken sleeping pills; he had only taken paracetamol for a headache. I made it clear that waiting was not an option. He needed to go down now, and we needed to figure out how.
After briefly considering carrying him — and potentially enlisting the group — the guides settled on tying him securely to the horse, with one person leading and two guides positioned on either side to catch him if he lost consciousness. It wasn't an elegant solution, but it was the one available. They got him moving.
While this was happening, we called his emergency contact and notified his travel insurance. Ararat's reliable cell coverage across the entire standard route turned out to be genuinely valuable here — we could coordinate in real time. Insurance confirmed he could be treated at any hospital in the area. We arranged for an SUV to be waiting at base camp to take him directly to the nearest private hospital.
As he arrived at base camp, the guides noted he seemed more alert — lower altitude was already helping. They asked whether he really needed to go to hospital, or whether he might recover at camp. I saw him. He still couldn't walk unassisted and wasn't thinking clearly. We went to the hospital.
The first stop was Özel Mediza Hastanesi, the private hospital in Doğubayazıt. They gave him oxygen and medication, took an X-ray, and identified fluid in the lungs — confirming HAPE. They acted quickly, but concluded they weren't equipped to manage his condition and transferred him by ambulance to the teaching hospital in Ağrı, 120km away.
This surprised me. The hospital closest to a mountain known for altitude-related emergencies did not appear to be set up or experienced in treating them. For comparison: the small hospital in Lukla, Nepal — the gateway to Everest — handles HAPE with apparent confidence as a matter of routine. The gap in readiness was striking.
We were fortunate that Yulia, our expedition coordinator, had stayed in Doğubayazıt while we were on the mountain. She accompanied him to both hospitals and served as the communication link between him, his emergency contact, the medical teams, and our group. Without her, the coordination would have been significantly harder.
At the teaching hospital in Ağrı he was admitted to the ICU. Staff confiscated his phone, which complicated communication. The hospital didn't have all the medications they needed and sent Yulia to a pharmacy to purchase them. With oxygen and treatment he began improving almost immediately, but they kept him in the ICU for three nights. His partner flew in to be with him. He was eventually discharged and made a full recovery.
HAPE and HACE can kill. This situation had a good outcome, but it didn't have to — and some of what helped was luck. These are the things we're doing differently going forward:
Ararat is a real mountain, and it deserves real preparation. For most climbers, on most attempts, it goes well. This is the account of when it didn't — and what we're carrying forward from it.
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